DIABETES TREATMENT W/CHINESE HERBS #6

CLINICAL APPLICATIONS
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

A sampling of clinical recommendations and evaluative trials for the treatment of diabetes is presented in the book Modern Clinic Necessities for Traditional Chinese Medicine (17). The formulas that had been shown to have hypoglycemic effects in the animal studies, Rehmannia Six Formula and Ginseng and Gypsum Combination, were recommended to treat those who have normal insulin secretion but suffer from diabetes (this would be type 2, or insulin-independent diabetes). These formulas are for the common qi and yin deficiency syndrome. A traditional variation of Rehmannia Six Formula may also be appropriate, made by adding anemarrhena and phellodendron.

Reducing Sugar Tablet A (Jiang Tang Jia Pian), comprised of astragalus, polygonatum, trichosanthes root, pseudostellaria, and rehmannia, was recommended for those with low levels of insulin, but who are still capable of producing insulin. The herbs were administered as extracts in tablet form, with 2.3 grams raw material per tablet, 6 tablets each time, three times daily, for a total dose of over 40 grams per day (raw materials equivalent). The effects were said to be enhancing sugar tolerance and elevating the level of serum insulin. In the treatment of 405 cases of diabetes with this preparation at the Guanganmen Hospital, 76.5% of the patients had improved sugar tolerance. Among those patients who most closely fit the therapeutic pattern of the herbs-those with qi and yin deficiency-the effective rate was slightly higher, 81%.

Rehmannia Eight Formula was recommended for those patients who produced little or no insulin. This is for patients with advanced disease, representing a deficiency of yin and yang (the cinnamon bark and aconite added to Rehmannia Six Formula to produce Rehmannia Eight Formula are said to restore yang). In laboratory animal studies, use of this formula resulted in reduction of water demand (thirst), blood sugar, and sugar spill into the urine. As a result of positive reports resulting from use of this formula for diabetes in Japan, the current author recommended it for those with early-onset diabetes beginning in 1981, using mainly the patent medicine from China, variously called "Sexoton Pills" or "Golden Book Tea" which is the Rehmannia Eight Formula (Ba Wei Di Huang Wan). When consumed in the amount of 12 pills each time, three times daily, it could help reduce the fluctuations in blood sugar that were experienced by insulin-dependent patients who had difficulties gaining control of blood sugar levels. As a result, there was a slight reduction in total insulin usage, but the main benefit was more reliable effects of insulin.

Jade Spring Pill (Yu Quan Wan), a patent formula from China, is recommended for diabetes treatment in the dosage of 50 grams per day (the original form was large honey pills of about 6 grams each), for at least one month. In laboratory animal studies, this formula was shown to increase glycogen in liver cells (the single herb rehmannia also has this effect in laboratory animals). When the current author visited the Sichuan Province United Pharmaceutical Manufactory, a new product was presented: the second generation of "Yuechung Pills" (Jade Spring Pills), comprised of pueraria, trichosanthes root, rehmannia, licorice, schizandra, and other herbs not mentioned on the label. These pills are indicated in the package labeling for the "ill function of the islets of Langerhans." The relatively small pills are packed into small bottles with a total of 6 grams each, and 20 bottles are packed in one box, accompanied by instructions to take one bottle each time, four times daily (the box is a five day supply at 24 grams/day). Compared to the first generation, it is said on the package insert, the new product had been clinically proved to have an improved rate of cure and that the dose had been reduced. Jade Spring Pill is useful for the early stage of diabetes, when yin deficiency and dryness dominate. In a recent clinical evaluation of a Chinese herb formula for diabetes, Jade Spring Pills, used for the control group, was reported to be effective in reducing blood sugar for 79% of cases treated (33).

Several clinical trials have been reported in Chinese medical journals with brief English summaries appearing in Abstracts of Chinese Medicine (a Hong Kong publication). A representative report is one that originally appeared in the Journal of the Zhejiang Traditional Chinese Medical College in 1989 (18). Patients were treated with a decoction containing astragalus, codonopsis, rehmannia, gypsum, salvia, persica, carthamus, atractylodes (cangzhu), anemarrhena, and tang-kuei. This combination of qi and yin tonics plus blood-vitalizing herbs is appropriate to treating patients with a middle stage disease showing some secondary symptoms. Modifications of the formula would also be made for the specific symptoms. The patients showed a variety of secondary manifestations of the disease, including nephropathy, peripheral neuropathy, dermatological disorders, retinitis, and liver cirrhosis. Among 19 non-insulin dependent cases treated, fasting blood glucose levels decreased from the pretreatment range of 160-300 mg% to 80-110 mg%. One patient with insulin dependent diabetes showed a decline in fasting blood sugar from 500 mg% before treatment to readings of 110-200 mg% after treatment. Generally, it was found that blood glucose decreased after 1-2 weeks of treatment and became steady after one month, and the blood glucose changes were followed by symptomatic improvements.

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